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Dexamethasone- cyclophosphamide pulse in collagen vascular diseases: An observation

Sudip Das1, Parag Prasun Giri, Aloke Kr Roy

  • 1Department of Dermatology and Venerology, NRS Medical College, Kolkata, India.

Indian Dermatology Online Journal
|November 7, 2012
PubMed

Insights

Dexamethasone-cyclophosphamide pulse (DCP) therapy shows significant improvement in various autoimmune diseases like systemic sclerosis, SLE, and dermatomyositis. Early intervention with DCP is associated with better patient outcomes and is a cost-effective treatment option.

Area of Science:

  • Rheumatology
  • Immunology
  • Dermatology

Background:

  • Collagen vascular diseases, including systemic sclerosis, dermatomyositis, and systemic lupus erythematosus (SLE), present significant treatment challenges.
  • The success of dexamethasone-cyclophosphamide pulse (DCP) in pemphigus has led to its exploration in other autoimmune conditions.

Purpose of the Study:

  • To evaluate the efficacy and safety of dexamethasone-cyclophosphamide pulse (DCP) therapy in patients with systemic sclerosis, dermatomyositis, SLE, and overlap syndromes.
  • To compare DCP with other treatment modalities, such as methylprednisolone pulse and daily steroid regimens.

Main Methods:

  • DCP was administered for six to nine pulses according to a standard regimen.
  • Immunosuppressive therapy duration varied: 12-18 months for dermatomyositis, SLE, and overlap syndromes; 12 months for systemic sclerosis.
  • Oral steroid doses were gradually tapered off throughout the treatment period.

Main Results:

  • Significant improvements were observed in systemic sclerosis (skin binding 90%, exertional dyspnea 80%, dysphagia 40%), with minimal effect on Raynaud's phenomenon and digital tip ulcerations.
  • In SLE patients, malar rash (70%), joint pain (80%), oral ulcerations (80%), fever (98%), and photosensitivity (33%) showed improvement.
  • Dermatomyositis patients experienced improvements in muscle tenderness (100%), proximal myopathy (80%), heliotrope rash (80%), and shawl sign (80%).
  • Overall, 25-30% of patients experienced side effects including hypertension, hyperglycemia, and infections.

Conclusions:

  • Dexamethasone-cyclophosphamide pulse (DCP) is a relatively safe, effective, and inexpensive alternative to methylprednisolone pulse therapy.
  • DCP is associated with fewer side effects compared to daily steroid regimens.
  • Early initiation of DCP therapy correlates with improved patient response.
Abstract

Keywords:
Collagen vascular diseasedexamethasone-cyclophosphamide pulse

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